Dental Consultant (Orthodontist) - Roseville, CA
Gainwell Technologies
- Roseville, CA
- $116,100-165,900 per year
- Permanent
- Full-time
- Review dental records to determine medical necessity of orthodontic services within professionally recognized standards of care.
- Manually adjudicate Treatment Authorization Requests (TARs), Notices of Authorization (NOAs) and Claim Inquiry Forms (CIFs) utilizing standards and procedures set forth by the CA Department of Health Care Services (DHCS) to ensure adherence to Medi-Cal Dental policies and procedures.
- Work within a team of dental consultants, including other orthodontists, sharing a proportional workload of prior authorization and/or claims processing that have been determined to need professional expertise of an experienced orthodontist. Good communication skills are necessary for continuity within the business operations.
- Assist with training and orientation of new dental consultants, providing guidance and mentoring, such as job coaching and peer interaction including assistance with complex cases or claims.
- Assists other departments, when requested: a) Claims Processing and Operations, b) Provider and Member Services, c) Grievances/Appeals, d) HR/Onboarding/Interviews, e) Quality Management, f) Peer review, and g) Providing findings to the claims processing team and/or adjudication of claims related to Orthodontic cases.
- A minimum of ten (10) years of prior hands-on, clinical experience as an Orthodontic Specialist delivering dental services. The candidate must be a recognized Specialist in Orthodontics and meet all requirements and training set forth by the Board of Dental Examiners in California.
- Possession of active (non-expired) license to practice dentistry in CA, which is in good-standing and free of any suspensions or sanctions from Federal, State, or local jurisdictions.
- Prior adjudication and claims processing for the Medi-Cal Dental Program in CA is a plus, but not a requirement.
- Expertise and knowledge of Medi-Cal Dental criteria and program requirements.
- Must be an Orthodontist.
- Position will be hybrid with 3 days on-site (Roseville, CA) and and 2 days working from home.
- The work week is Monday through Friday.
- Full-time (40 hours per week) salaried employee benefit package
- In order to effectively work as a teleworker with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
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